Basic Information
| Provider Information | |||||||||
| NPI: | 1841394483 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUCKIEWICZ | ||||||||
| FirstName: | JAY | ||||||||
| MiddleName: | PATRICK | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 602 MALLARD WAY | ||||||||
| Address2: | |||||||||
| City: | PEEKSKILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105664177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147370169 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | DEPARTMENT OF VETERANS AFFAIRS | ||||||||
| Address2: | HUDSON VALLEY HEALTH CARE SYSTEM | ||||||||
| City: | MONTROSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147374400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 1369 | AZ | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.